MEDICARE: MINDSET BEHAVIORAL HEALTH PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881431930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDSET BEHAVIORAL HEALTH PC

Provider Business Mailing Address
First Line	:	745 ABBEY RD
Second Line	:
City	:	PITTSBORO
State	:	IN
Zip	:	46167-8994
Country	:	US
Telephone Number	:	317-554-7419
Fax Number	:	812-559-9192

Provider Business Practice Location Address
First Line	:	7230 ARBUCKLE CMNS STE 203
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-1795
Country	:	US
Telephone Number	:	317-554-7419
Fax Number	:	812-559-9192

Authorized Official
Title or Position	:	OWNER
Name	:	KIMBERLY MAE HIZER
Credential	:	PMHNP-BC
Telephone Number	:	317-554-7419

Provider Enumeration Date	:	07/15/2024
Last Update Date	:	08/26/2024

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